00050181"C1 nm DING m ESSIIONNO '
C®NTRA"CTOR INF,OO RMATION. -;
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PERMIT'
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BUILDINGADb@308 ALPINE DR
'- JUST, WATER HEATERS'
OEpMIT NO,
OWNER'SNAj!ILIHRYCKY ZENON ET- AL
'NATIOACVE
nPPucaION SUB Dnre
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'HONE:
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SANITARY NO. L
c ARCHITECTIENOINEER:-
(51,0)
- BUILDING PERMIT INFO
42'93-9901 -
BLDG ELECT. e PLUMB h1ECH ,
LICENSED CONTRACTORS DFCI ARAI'ION
Job D05CIlp[IOn - "
Ilamby +Won thinl licensed d p fChpl 9( memng
lith Section 7000) of D.- .
" n3OrtheO ndPmfesv n.Coil,dndon [case
' t n r and efr t.- ♦
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Date Cromancluar •
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"ARCHITECT'S DECLARATION -
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jI tridtastand. y Irrm shall fe used as pubhe record
REPLACE .100.GALLON WATER HEATER
Lwamul Professional
i. - OWNER" BUILDER DECLARATION
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I hereby afCum That I it, exempt final the Commcwrs License Luw far the
'¢ fallowing feasor. (Section 7031.5. Business and Professions Cade: Any city or county
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] which requires a permit to construct alter, improve, demolish, orrepairany structure
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. prior to its issuance, also requires the applicant for such permit o file a signed storeman
Sq; Pt. Il OOC Area,
Valuation
that he klicensed pursuant tthe ministers mile,Contractor v L' La (Chapter9
(c ru n 6 with Set ]0007 f Division'J I the B. d P f .:' n Code)
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$ 199H
or thin h . a empl th f d the b f thealleged la Any violation
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'ofSection 70TISby y appliLutforap 'Isubjects the applicant it) isilpentlly
Of act than two hundred driller, ($500)
.. AP
i[iT�71.
-Occupancy Type
❑1,asohe ork,andthe inroYe
Intendedth agesOr
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isPhe, .tot(Sca. 744,
wll do he k and the income t offered
Intended off d f (S ]044,
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Business and P l; i Cods: T I . J t, pply m at
tit L c c,, of
, ReC1111Ced IHSpeCt1o11S
bolds lir:.loaves thereon and o
r of pmpertya h tinea such work himself
1. n
or as improvements
through his own employees. provided that such :omen, oldarc non Trended-
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nffeml for s:Je. If, however, the builJing nr impniu'ement ix sold within ane year of
is
completion, the Owner-builder will have the burden nCproving Olathe did Alit build or
'mprovemrporposeofsale.). ,. '. t .,
50^2., _
' Fd NAL PLUMPING ENERGY ,t,
Cl I; a, owner of the la pony, .,It b.aw.i,elyenmmera, m
with beerwad ctormarx 1.
5!Z16 GAS TEST
: ee 7044, Broo and rn r :: : Coo ) The Contractor's
.I rthe p j (s
'Id.
- 507 — FINAL PLUNKING , ^
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1 1 t apply men owner r ....... lo who) p vas thereon,
and
and h contracts for such pmJects with i a mqs) licensed p unto .the
Contraction's l: License Law..
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❑1 pt under -� - B&PCfor Ih:
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WORKER S COMPENSATION DECLARATION,
Ihereby thrm underRrally offactory one fike ticllbw,ltgdeclaration,
t h e J voll 't' Ccr,firme ofC , v in - soff-amme for Worker'.,
Cithro'eh'thmn. a,provided for by, Section 3700 of the Labor Code; for the
pati cofthew k for which itis Dmil', erred.
0 1 have and will maintain Wurker'i Compensation Bwarance, as required by Sectio
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3700 of the Ini m Code. for the pemnemance of the walk for which this permit is
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smwd. My Worker', Compensmion lnsuraaee carrier and Policy mmtbar
Caner:' - P,I'YNn:
CERTIFICATION OF EXEMPT ION FROM WORKERS'
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COMPENSATION INSURANCE
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(This smtim need non he completed if the permit is for one hundred dollars
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($100) or off.)
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I certify that in the perfotmunre of the work for which This permit is issued, 1
shall not employ any Person In any manner or ns to become subject tdthe Workers'
Cn p :'.Laws sfClT '.Dale
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Applicant
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NOTICE FOAPPLICANf It,aftmookingthsC tfeine ofLxeupfal you.hotid-
e
htcomesublect nn tire Workers Cmpens(- pawisim, of the Labor Code you mus.
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fntlhwith comply with such provisions or this pernut shall be damned revoked.
' CONS FRUCT10N LENDING AGENCY"
Ihereby aifrni(hill ihere is a canstmcOon lending agency for the performance
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Of the work for which this permit Is issued (See 3097, Civ, G) -
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Lenders Name b'
N
Lender's Address
I xhily that 1 hnvc read'thls appllce0on and state that the above Infnrmdtlon is
rectal ogee to emnllywith all city ..,I county oidinances and state laws relining
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tobuildingconshuction, and hereby authorize represemmives ofthis city to enlerupoll
the afawe meal oned'p 'p ny f ..... firm p rptses. 1"-
(W) g i um 'tyadkeep h l;: the City ofCp t ngulm,t
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liabilities, iudgmems, art, and pla es which may n nay y r e against said
City in consequence of the Stenting of this peri nit.
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APPLICANT UNDERSTANDS AND W ILL COMPLY WITH�ALLNON-POINT
SOURCE REGULATIONS.
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Issued by: Date
Signature of Applicam/Cnnbaam ,. t .- :Dale'
Re-roofs 17
HAZARDOUS MATERIALS DISCLOSURE'
Will the applicant lir imurc budding occupant store or handle hazardous material
Type. of ROOf - e
os dellued by the Cupertino Municipal Code, Chapin 9.12. and the Health Sind Safety
Cale, Scotian 25532(.)1 I-
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❑Yea El No,
which
All roofs shall. be inspected prior to any roofing material being installed.
Will he appficam or future•mtifdl.g occupant ase egmpme.tm device,
ho
If a roof is installed without first obtaining an inspection, ,f agree to remove "
emit color, ell contaminants as defiiied by the Boy Arw A it Coal it, Management
ice
0Nall
o
all new materials for inspection. Applicant understands and will comply with-
El Yes
non-point source regulations.
-1 have and the Ir rich, ouralliollq me ns u de 6pler 6,95'of the
CabfOrn a Heahh &Sf ty Code, S.tie., 25505 25533.nd 25534.1 mulerstand ihm
Wv
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ifihebuildingdoesnoteamentlyhaveatennm, that it is myresponsihilily lonntify the-
Mnupent of the requirements which mull he run prior to Issuance of a Certificate of
Signature of Applicant t., - Date
- - All roof coverings' to be Class r`B" or better
.e..
Owner Or authorized agents' Date -
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" OFFICEo-